Prevalence and predictors of sub-optimal serum gentamicin levels in sickle cell disease patients undergoing Hartford protocol

Other Title(s)

شيوع و مؤشرات المستوى دون الأمثل للجنتامايسين في دم مرضى الأنيميا المنجلية الخاضعين للعلاج حسب بروتوكول هارتفورد

Dissertant

Abu Sham, Ahmad Abd al-Rahim Ali

Thesis advisor

al-Zakwani, Ibrahim S.
al-Kindi, Salam M. Z.
Muhammad, Abd al-Wahhab Hasan

University

Omdurman Islamic University

Faculty

Faculty of Pharmacy

Department

Department of Clinical Pharmacy

University Country

Sudan

Degree

Ph.D.

Degree Date

2009

English Abstract

This was a retrospective study analysis conducted in a university teaching hospital over a 3.5-year period from January 2005 to May 2008.

Four-hundred and seven serum gentamicin level (SGL) episodes representing 248 patients were evaluated.

The overall mean age of the study cohort was 23±5 with males representing 54 % (n = 219) of the subjects.

Three hundred and thirty nine (83 %) of the 407 episodes, were considered suboptimal levels (< 1 mcg / ml).

Multivariate analysis using logistic regression revealed increasing odds of having suboptimal SGL 8-hour post gentamicin infusion with younger age and higher creatinine clearance.

Patients who are 23 years or younger are 2-fold more likely to have suboptimal SGL compared with those who are above 23 years of age (95 % CI : 1.1-3.3; p = 0.026).

Patients with creatinine clearance of 200 ml/min and above are 3.8 times more likely to have suboptimal SGL compared to those with creatinine clearance less than 200 ml/min (95 % CI : 1.9-7.4 ; p < 0.001).

Furthermore, the logistic regression model demonstrated that with each one unit increase in serum urea, patients were 20 percent less likely to have suboptimal SGL (95 % CI : 0.73 -0.97 ; p = 0.017) and that patients who are on piperacillin±tazobactam therapy given concurrently with gentamicin, are 50 percent less likely to have suboptimal SGL (95 % CI : 0.6-0.81 ; p = 0.007).

This study has demonstrated that the majority of SCD patients undergoing Hartford protocol had suboptimal SGL 8-hour after drug administration.

Suboptimal levels appeared to be significantly related to young age and rapid clearance of drug.

The resulting 16 hours spent below the MIC of micro-organisms may represent a potential for therapeutic failure.

We recommend that the existing Hartford monogram should be modified to fit SCD patients’ population depending on clinical outcome; otherwise clinicians may revert to traditional gentamicin therapy.

Main Subjects

Medicine

Topics

• Patients
• Antibacterial agents
• Aminoglycosides

No. of Pages

68

Table of Contents

• APA
• MLA
• AMA

Language

English

Data Type

Arab Theses

Record ID

BIM-366171